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01-04-2017 | Original Article

Impact of tumor histology and grade on treatment success of percutaneous renal cryoablation

Authors: Alp Tuna Beksac, Gerant Rivera-Sanfeliz, Catherine A. Dufour, Unwanaobong Nseyo, Zachary Hamilton, Sean W. Berquist, Abd-elRahman Hassan, Omer A. Raheem, Song Wang, Robert W. Wake, Robert E. Gold, Ithaar H. Derweesh

Published in: World Journal of Urology | Issue 4/2017

Abstract

Background

We analyzed oncological outcomes in patients who underwent percutaneous renal cryoablation (PRC) with documented renal cell carcinoma (RCC) by perioperative biopsy.

Methods

Multicenter retrospective analysis of 153 patients [median follow-up 48 months] who underwent PRC from 09/2005 to 08/2014 was performed. We divided the cohort into patients who developed recurrence versus no recurrence. Kaplan–Meier analyses examined recurrence-free survival (RFS) according to grade and histology. Multivariable analysis (MVA) was performed to identify factors associated with tumor recurrence.

Results

One hundred and fifty-three patients were analyzed [18 patients (11.8 %) with recurrence and 135 (88.2 %) patients without recurrence]. There were no differences between the groups with respect to demographics, RENAL score, and number of probes utilized. Recurrence group had larger tumor size (3.1 vs. 2.4 cm; p = 0.011), upper pole tumor location (p = 0.016), and greater proportions of high-grade tumor (33 vs. 0.7 %; p < 0.001) and clear cell histology (77.8 vs. 45.9 %; p = 0.011). Four-year RFS was 100 versus 80 % for grade 1 versus grade 2/3 tumors (p = 0.0002), and 97 versus 88 % for other RCC versus clear cell RCC (p = 0.07). MVA demonstrated tumor size >3 cm (OR 2.46; p = 0.019), clear cell histology (OR 2.12; p = 0.027), and high tumor grade (OR 2.33, p < 0.001) as independent risk factors associated with tumor recurrence.

Conclusions

Association of higher grade and clear cell histology with recurrence and progression suggests need for increased emphasis on preoperative risk stratification by biopsy, with grade 1 and non-clear cell RCC being associated with improved treatment success than higher grade and clear cell RCC.

Kane CJ, Mallin K, Ritchey J, Cooperberg MR, Carroll PR (2008) Renal cell cancer stage migration: analysis of the National Cancer Data Base. Cancer 113:78–83CrossRefPubMed

Bhargavan M, Sunshine JH (2005) Utilization of radiology services in the United States: levels and trends in modalities, regions, and populations. Radiology 234:824–832CrossRefPubMed

Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY (2004) Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 351:1296–1305CrossRefPubMed

Van Poppel H, Da Pozzo L, Albrecht W et al (2011) A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 59:543–552CrossRefPubMed

Campbell SC, Novick AC, Belldegrun A et al (2009) Guideline for management of the clinical T1 renal mass. J Urol 182:1271–1279CrossRefPubMed

Ljungberg B, Bensalah K, Canfield S et al (2015) EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 67:913–924CrossRefPubMed

Derweesh IH, Malcolm JB, Diblasio CJ et al (2008) Single center comparison of laparoscopic cryoablation and CT-guided percutaneous cryoablation for renal tumors. J Endourol 22:2461–2467CrossRefPubMed

Hötker AM, Karlo CA, Zheng J et al (2016) Clear cell renal cell carcinoma: associations between CT features and patient survival. AJR Am J Roentgenol 206:1023–1030CrossRefPubMed

Donat SM, Diaz M, Bishoff JT et al (2013) Follow-up for clinically localized renal neoplasms: AUA guideline. J Urol 190:407–416CrossRefPubMed

10.

Kutikov A, Uzzo RG (2009) The RENAL nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182:844–853CrossRefPubMed

11.

Weight CJ, Atwell TD, Fazzio RT et al (2011) A multidisciplinary evaluation of inter-reviewer agreement of the nephrometry score and the prediction of long-term outcomes. J Urol 186:1223–1228CrossRefPubMed

12.

Stroup SP, Palazzi K, Kopp RP et al (2012) RENAL nephrometry score is associated with operative approach for partial nephrectomy and urine leak. Urology 80:151–156CrossRefPubMed

13.

Woldrich JM, Palazzi K, Stroup SP et al (2013) Trends in the surgical management of localized renal masses: thermal ablation, partial and radical nephrectomy in the USA, 1998–2008. BJU Int 111:1261–1268CrossRefPubMed

14.

Zargar H, Samarasekera D, Khalifeh A et al (2015) Laparoscopic versus percutaneous cryoablation for the small renal mass: 15 year experience at a single center. Urology 85:850–855CrossRefPubMed

15.

Blute ML, Okhunov Z, Moreira DM et al (2013) Image-guided percutaneous renal cryoablation: preoperative risk factors for recurrence and complications. BJU Int 111:E181–E185CrossRefPubMed

16.

Georgiades CS, Rodriguez R (2014) Efficacy and safety of percutaneous cryoablation for stage 1A/B renal cell carcinoma: results of a prospective, single-arm, 5 year study. Cardiovasc Intervent Radiol 37:1494–1499CrossRefPubMed

17.

Caputo PA, Ramirez D, Zargar H et al (2015) Laparoscopic cryoablation for renal cell carcinoma: 100 month oncologic outcomes. J Urol 194:892–896CrossRefPubMed

18.

Klatte T, Shariat SF, Remzi M (2014) Systematic review and meta-analysis of perioperative and oncologic outcomes of laparoscopic cryoablation versus laparoscopic partial nephrectomy for the treatment of small renal tumors. J Urol 191:1209–1217CrossRefPubMed

19.

Motzer RJ, Jonasch E, Agarwal N et al (2014) Kidney cancer, version 2.2014. J Natl Compr Canc Netw 12:175–182PubMed

20.

Lang EK, Zhang KK, Nguyen Q, Myers L, Allaf M, Colon I (2015) Efficacy of percutaneous cryoablation of renal cell carcinoma in older patients with medical comorbidities: outcome study in 70 patients. Can Urol Assoc J 9:E256–E261CrossRefPubMedPubMedCentral

21.

Lay AH, Faddegon S, Olweny EO et al (2015) Oncologic efficacy of radio frequency ablation for small renal masses: clear cell versus papillary subtype. J Urol 194:653–657CrossRefPubMed

22.

Ma CH, Jiang R, Li JD, Wang B, Sun LW, Lv Y (2014) Experimental study on residual tumor angiogenesis after cryoablation. Asian Pac J Cancer Prev 15:2491–2494CrossRefPubMed

23.

Menogue SR, O’Brien BA, Brown AL, Cohen RJ (2013) Percutaneous core biopsy of small renal mass lesions: a diagnostic tool to better stratify patients for surgical intervention. BJU Int 111:E146–E151CrossRefPubMed

24.

Babaian KN, Okhunov Z, Juncal S et al (2015) Clinical outcomes of patients with nondiagnostic biopsy during cryoablation of small renal masses. Urology 85:605–609CrossRefPubMed

25.

Halverson SJ, Kunju LP, Bhalla R et al (2013) Accuracy of determining small renal mass management with risk stratified biopsies: confirmation by final pathology. J Urol 189:441–446CrossRefPubMed

26.

Kopp RP, Aganovic L, Palazzi KL, Cassidy FH, Sakamoto K, Derweesh IH (2013) Differentiation of clear from non-clear cell renal cell carcinoma using CT washout formula. Can J Urol 20:6790–6797PubMed

27.

Breen DJ, Bryant TJ, Abbas A et al (2013) Percutaneous cryoablation of renal tumours: outcomes from 171 tumours in 147 patients. BJU Int 112:758–765CrossRefPubMed

28.

Kutikov A, Egleston BL, Canter D, Smaldone MC, Wong YN, Uzzo RG (2012) Competing risks of death in patients with localized renal cell carcinoma: a comorbidity based model. J Urol 188:2077–2083CrossRefPubMedPubMedCentral

29.

Jiménez JA, Zhang Z, Zhao J et al (2016) Surgical salvage of thermal ablation failures for renal cell carcinoma. J Urol 195:594–600CrossRefPubMed

30.

Karam JA, Wood CG, Compton ZR et al (2015) Salvage surgery after energy ablation for renal masses. BJU Int 115:74–80CrossRefPubMed

Title: Impact of tumor histology and grade on treatment success of percutaneous renal cryoablation
Authors: Alp Tuna Beksac
Gerant Rivera-Sanfeliz
Catherine A. Dufour
Unwanaobong Nseyo
Zachary Hamilton
Sean W. Berquist
Abd-elRahman Hassan
Omer A. Raheem
Song Wang
Robert W. Wake
Robert E. Gold
Ithaar H. Derweesh
Publication date: 01-04-2017
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 4/2017
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-016-1911-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Impact of tumor histology and grade on treatment success of percutaneous renal cryoablation

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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